CDC: Many kids with Medicaid use ER as doctor’s office

Children covered by Medicaid, the publicly funded insurance program for the poor, visit the emergency room for medical care far more often than uninsured or privately insured youngsters, a U.S. survey finds.

And kids with Medicaid were more likely than those with private insurance to visit for a reason other than a serious medical problem, according to the 2012 survey conducted by the U.S. Centers for Disease Control and Prevention.

Reliance on ER care for non-urgent health problems is an issue because of soaring health costs. The U.S. National Institutes of Health says treatment in an ER can cost two to three times more than the same care in a doctor’s office.

Dr. Rodney Baker, director of pediatric emergency services at Miami Children’s Hospital in Florida, said one reason the uninsured and Medicaid patients turn to the emergency room is that they can’t find a doctor to treat them.

“In many parts of the country, patients cannot find doctors who will take Medicaid patients,” he said. With the expansion of Medicaid under the Affordable Care Act, emergency room visits might actually increase, he added.

In 2012, regardless of insurance, three-quarters of children’s ER visits occurred at night or on weekends when doctors’ offices were closed, according to the report released July 24 in the NCHS Data Brief.

About one-quarter of children with Medicaid went to an emergency room at least once that year, the survey found, far more than uninsured kids (16 percent) or children with private insurance (13 percent). These differences held whether the patients went just once or two times or more.

True emergencies led similar proportions of Medicaid and uninsured patients to visit the ER — 61 percent and 59 percent, respectively. A greater number of kids with private insurance — more than two-thirds — had a serious condition steer them to the emergency room, the findings showed.

Nearly eight out of 10 parents said they took their child to the emergency room because they thought “only a hospital could help.” And 62 percent said the problem was “too serious for a doctor’s office,” the researchers said.

About 43 percent of privately insured children went to the ER because their doctor told them to, compared with about 36 percent of children with Medicaid. Just two out of 10 uninsured children went on a doctor’s recommendation, according to the report.

In all, only about 10 percent of children at the ER for serious conditions were taken by ambulance, the researchers found.

Renee Gindi, a survey statistician at the CDC’s National Center for Health Statistics and lead author of the report, said she expects the Affordable Care Act will ease the situation.

“These changes in children’s health insurance coverage will lead to more preventive care, having a usual source of care — a medical home — and that would alleviate this emergency room use,” she said.

Because the report is based on data from 2012, the full effect of the Affordable Care Act isn’t reflected, Gindi said.